Korean Journal of Anesthesiology最新文献

Background: Klinefelter syndrome (KS), usually the 47,XXY karyotype, is the most common sex chromosome anomaly in males. However, many cases remain undiagnosed because the clinical presentation is highly variable and physicians are not sufficiently trained to assess for this condition. To the best of our knowledge, only three detailed reports on anesthesia in patients with KS are currently available.

Case: We report the case of a 74-year-old male with KS who underwent ureterorenoscopy under general anesthesia. Despite the characteristic clinical presentation of KS and its typical sequelae, the course of anesthesia was unremarkable.

Conclusions: Despite the unremarkable anaesthetic course in our case, anesthetists should be aware of the potential for a difficult airway and cardiovascular and other complications associated with this syndrome. During preoperative examination, attention should be paid to common secondary manifestations of KS to avoid perioperative complications.

Background: The transvenous approach to the treatment of cerebral arteriovenous malformation (AVM) is difficult and requires strict blood pressure and blood flow control; however, the cure rate is very high. Appropriate blood pressure control techniques can greatly benefit these patients.

Case: A 55-year-old male patient was found to have an aneurysm complicated with a cerebral AVM (length: 2.0 cm, width: 1.6 cm, height: 1.2 cm). Aneurysm embolization was considered for the first-stage surgery and transvenous arteriovenous malformation embolization for the second-stage surgery. Rapid ventricular pacing (RVP) provided a stable blood flow environment for the surgery, which was completed successfully.

Conclusion: RVP can thus provide an ideal condition for the embolization of cerebral AVM through the transvenous approach and can be a viable surgical option.

Background: We aimed to determine whether propofol-based total intravenous anesthesia (TIVA) is associated with mortality and morbidity following cranial neurosurgery compared with inhalation anesthesia.

Methods: This nationwide, retrospective, population-based cohort study included patients who underwent cranial neurosurgery under general anesthesia between January 1, 2016, and December 31, 2021. The two study endpoints were 90-day mortality and postoperative complications.

Results: In total, 144,506 adult patients were included: 65,442 patients (45.3%) who received TIVA (TIVA group) and 79,064 (54.7%) who received inhalation anesthesia (inhalation anesthesia group). After propensity score (PS) matching, 97,156 patients (48,578 in each group) were included. The 90-day mortality rates after cranial neurosurgery were 14.0% (6,660 / 48,578) in the TIVA group and 14.2% (6,779 / 48,578) in the inhalation anesthesia group. Moreover, the postoperative complication rates following cranial neurosurgery were 47.1% (22,411 / 48,578) and 50.3% (23,912 / 48,578) in the TIVA and inhalation anesthesia groups, respectively. Based on the logistic regression analysis, TIVA was not associated with 90-day mortality compared with inhalation anesthesia (odds ratio [OR]: 0.97, 95% CI: 0.94, 1.01; P = 0.188) in the PS-matched cohort. Logistic regression analysis revealed that the TIVA group had a 12% (OR: 0.88, 95% CI: 0.86, 0.90; P < 0.0.001) lower postoperative complication rate than the inhalation anesthesia group.

Conclusions: There was no significant association between the type of anesthesia and postoperative 90-day mortality in patients who underwent cranial neurosurgery in South Korea. However, propofol-based TIVA was associated with a lower incidence of postoperative complications than inhalation anesthesia.

Background: Preventing intraoperative nausea and vomiting (IONV) is crucial for maternal safety during cesarean section under spinal anesthesia. While midazolam is known to prevent IONV, we hypothesized that remimazolam would be superior due to its minimal hemodynamic effects. We compared the effects of the two drugs on IONV.

Methods: Parturients scheduled for cesarean section were randomly assigned to receive either midazolam or remimazolam. They received midazolam 2 mg or remimazolam 5 mg, with additional doses administered upon request. The primary outcome measure was the incidence of newly developed IONV during sedation. Other outcomes included overall IONV, rescue antiemetic use, shivering, hemodynamic variables, sedation scale scores, and satisfaction scores.

Results: Data from 80 participants were analyzed. Deeper sedation was induced in the remimazolam group (PGroup × Time < 0.001) despite comparable hemodynamic trends between the groups. The incidence of overall IONV was comparable between the two groups (27.5% in the midazolam group vs. 17.5% in the remimazolam group, absolute risk reduction [ARR]: 0.100, 95% confidence interval [CI] [-0.082, 0.282], P = 0.284); however, newly developed IONV during sedation was significantly reduced in the remimazolam group (20.0% vs. 5.0%, ARR: 0.150, 95% CI [0.009, 0.291], P = 0.043). The need for rescue antiemetics was also lower in the remimazolam group (15.0% vs. 2.5%, ARR: 0.125, 95% CI [0.004, 0.246], P = 0.048).

Conclusion: Remimazolam significantly reduced the incidence and severity of newly developed IONV compared with midazolam, with minimal impact on hemodynamics, making it a useful sedative option for cesarean section.

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ- cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.

Background: Ischemia-reperfusion (I/R) injury is inevitable during the perioperative period. The pancreas is susceptible to I/R injury. Autophagy, a self-digestion process, is upregulated during I/R injury and strongly induced by hypoxia. This study aims to determine whether dexmedetomidine can decrease pancreatic β-cell damage by regulating autophagy under hypoxia.

Methods: INS-1 rat insulinoma cells were cultured in dexmedetomidine before being exposed to cobalt chloride (CoCl2)-induced hypoxia. Cell viability and the expression of autophagy-related proteins (light chain 3B [LC3B]-II, p62, and ATGs) were assessed. The expression of apoptosis-related proteins (BCL-2 and P-BAD) were also evaluated. CoCl2-treated INS-1 cells were pretreated with the autophagosome formation inhibitor, 3-methyladenine (3-MA), to compare its effects with those of dexmedetomidine. Bafilomycin-A1 (Baf-A1) that inhibits autophagosome degradation was used to confirm the changes in autophagosome formation induced by dexmedetomidine.

Results: Dexmedetomidine attenuated the increased expression of autophagic proteins (LC3B-II, p62, and ATGs) and reversed the CoCl2-induced reduction in the proliferation of INS-1 cells after hypoxia. Dexmedetomidine also alleviated the decreased expression of the anti-apoptotic protein (BCL-2) and the increased expression of apoptotic protein (BAX). Dexmedetomidine reduces the activation of autophagy through inhibiting autophagosome formation, as confirmed by a decrease in LC3B-II/I ratio, a marker of autophagosome formation, in LC3B turnover assay combined with Baf-A1.

Conclusions: Dexmedetomidine alleviates the degree of cellular damage in INS-1 cells against CoCl2-induced hypoxia by regulating autophagosome formation. These results provide a basis for further studies to confirm these effects in clinical practice.